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Hair transplant surgery is on the rise – but what does the procedure actually involve, what are the risks, and are there alternatives? Here, we explain everything you need to know...

Hair transplant surgery

Techniques have become so advanced in recent years that FUE and FUT hair transplants can reverse female - or male -pattern baldness to the point where no one will know that you were ever losing your hair.

Breaking down the embarrassment-factor, a number of public figures have also spoken about having had hair transplant procedures. Footballer Wayne Rooney, actor James Nesbitt and reality TV star Calum Best have all gone on the record about it; while others, such as chef Gordon Ramsay, actor Rob Brydon and tennis player Rafa Nadal are all rumoured to have had transplants.

That said, it's not a decision to rush into: the cost is not insignificant and the effect will be dependent on who carries out the operation. So you need to know the different types of procedure and what questions to ask a hair transplant surgeon before making your decision.

But first, we need to understand what causes hair loss.

Rob Brydon is rumoured to have had a hair transplantCredit:
Mike Marsland/WireImage

What causes male-pattern hair loss

Around one in three men experiences male-pattern baldness to varying degrees by the age of 30. Hair grows from follicles below the surface of the skin and a single hair will normally last between three and five years before it’s shed, and a new hair grows from that follicle. This cycle continues throughout life.

Male pattern baldness occurs when a modified form of testosterone, Dihydrotestosterone (DHT), begins to attack the hair follicles. This results in the follicles miniaturising and producing thinner and shorter hairs. As your thicker hairs fall out and are replaced by these weaker ones, you start to thin out on top.

Balding can be reversed through a hair transplant procedureCredit:
Chris Hendros/Getty

Whether you go through this process depends on your genes. If they are coded to resist DHT, you’ll keep your hair. If they are coded to be susceptible, you’re in trouble. The follicles on the back and sides are usually coded to fend off Dihydrotestosterone, which is why it’s common for men to keep their hair there. The genes for hair loss can come from either parent.

Male-pattern hair loss is progressive, so if you start losing your hair happens at an early age, the overall effect is likely to be a very bald pate.

Female-pattern hair loss is more common than you might thinkCredit:
Getty

What causes female hair loss?

Hair loss among women is more common than you might think. It can be caused by a number of factors, including, like male-pattern hair loss, hormonal change. Specifically, these are male hormones (androgens) so the hair loss can happen any time from adolescence onwards, but is most likely to occur post-menopause when female hormones decrease and male hormones increase. As in male-pattern baldness, testosterone is converted to DHT and this results in the follicles producing smaller hairs.

FUE hair transplant

FUE transplants are the gold standard procedure. Single follicles are removed from the donor area of the scalp with a specialised cutting tool. These individual follicles are then inserted into tiny cuts made into the recipient site where they bed down. The skilled surgeon ensures that the recipient cuts are angle to reproduce the natural direction of your normal hair. The follicles then grow strong and healthy hairs in the previously bald patch.

FUT hair transplant

With FUT surgery, instead of taking individual follicles from the donor site on the scalp, your hair transplant surgeon cuts away a strip of them. This strip is then divided up into single follicles or small groups which are inserted as with the FUE procedure into the recipient area. Hence it's sometimes referred to as "strip harvesting".

Hair transplant surgery won't hurtCredit:
Ozan Kose/AFP

Hair transplant frequently asked questions

Does a hair transplant hurt?

You will have a local anaesthetic so the operation will be painless. You might have some discomfort during the healing process. Because FUT strip harvesting is more invasive, there’s likely to be a bit more than with the FUE procedure. Afterwards, any pain should be treatable with standard painkillers.

Will a hair transplant leave a scar?

FUE surgery shouldn’t leave a scar, so if you want to keep your hair short then it’s probably the better option. FUT surgery is likely to leave a scar on the donor site, although it can probably be hidden under medium-length hair .

How long does a hair transplant procedure take?

It depends on the scale of the operation ie how many individual follicles you are having transplanted, but normally about eight hours. FUE transplant recovery is fairly quick because there are no stitches. An FUT transplant will normally take around a month for a full recovery, during which time there is likely to be a little more discomfort than with FUE surgery. Your scalp might be quite red for a few weeks, so if you don’t want anyone to know, book a holiday.

How much does a hair transplant cost?

Follicular Unit Extraction surgery will cost anywhere from £5,000 to £12,000 depending on the scale of the operation. Follicular Unit Transplantation costs less because the surgeon can harvest a donor hair strip of follicles at once, cutting down the work. Expect to pay £5,000 to £8,000 for FUT.

How long before I see the results of my hair restoration?

The first results will be visible after about four months. The full effect of a hair transplant operation should be apparent at the one-year mark. It’s possible that the transplanted follicles will themselves eventually begin to shrink and produce smaller hairs, in which case another transplant procedure is an option.

How many procedures will it take?

Quite possibly one, but perhaps a few transplant procedures will be necessary for good coverage on the recipient sites.

How successful is a hair transplant?

With the normal caveat that everyone is different, most people who undergo FUE and FUT hair transplants are happy with the outcome. The success will largely depend on how many good follicles you have left, how big a recipient area you want to cover, and the skill of the hair transplant surgeon - which underlines how important it is to do your research on hair transplant clinics and getting their predictions for the outcome.

Is a hair transplant permanent?

Because the transplanted hairs will behave just as they would have done if they had stayed in the donor area, a transplant isn't guaranteed to last forever. But it will probably last a very long time.

Who is a suitable candidate for a hair transplant?

To state the obvious, you need to have some hair left to transplant. The more you have available, the better the resulting coverage. But you might be surprised how few healthy follicles you need for a reasonable effect. Anyone with Diffused Unpatterned Alopecia, which leads to hair falling out, is unlikely to be suitable.

How do I choose a hair transplant surgeon/clinic?

Personal recommendation is very useful. Also make sure you see before and after shots of their work. Speak to one of their past patients if you can. And ask how many hair transplant operations they have performed. Start with the International Alliance of Hair Restoration Surgeons. Take your time to research and choose.

There are numerous overseas clinics offer hair loss surgery, especially in India, Thailand and Turkey. They’re cheap, but you’re far less likely to know much about your surgeon’s background and if the procedure turns out badly, you’re going to have a bigger job getting them to put it right.

What are hair plugs?

Those awful 1980s hair plugs that made men look like they had doll-like ropes of hair? They don't exist any more. You can, if you have some, have them removed and replaced with FUE and FUT surgery.

Can women have a hair transplant?

Yes, although fewer will be suitable candidates than among men because the pattern of hair loss tends to be more widespread, meaning fewer good donor sites.

What are the risks of hair transplant surgery? Are there side-effects?

FUT and FUE transplants are generally very safe, but as with any surgical procedure, complications are possible. There may be swelling, bruising or bleeding; the existing hairs in the recipient area can die due to the shock of the procedure (they will normally return, but not always); small cysts can form, though these usually soon disappear or can be treated quite easily.

Can a hair transplant fail?

Yes, it’s possible for your body to reject the new follicles so the transplant fails. It's rare, though.

Alternatives to hair transplants

There are non-invasive methods for preserving and recovering thinning hair, such as the clinically proved hair loss medications Minoxidil and Finasteride.

Minoxidil

Minoxidil, often sold under the brand names Rogaine or Regaine, is an over-the-counter topical treatment - ie it doesn’t require a prescription and it comes as a foam or liquid that you massage into your scalp. Minoxidil works by increasing the flow of blood around your poor shrunken follicles, rejuvenating them and encouraging them to grow stronger hairs once more. The follicles’ growth phases are also lengthened.

Finasteride

Sold under its generic name of Finasteride or the brand name Propecia, Finasteride blocks production of dihydrotestosterone and therefore interrupts the process by which follicles begin to produce thinner hairs. Propecia is taken as a pill and is prescription-only, although some pharmacies will include a free private prescription in the sale cost. Otherwise you will have to go to your GP. If you’re lucky, they will provide it on the NHS, although some will say Finasteride is too expensive you have to pay for it yourself.

Hair loss shampoos

Unfortunately, those hair-loss shampoos and conditioners the promise the return of your luscious locks are selling you a pup. At best they they will make your hair temporarily thicker, but they’re unlikely to have much effect.

Hair loss supplements

There are lots of them out there - topical and oral treatments promising much. Like hair loss shampoos, they won’t help with female or male-pattern baldness, although they might have an effect if your hair loss is due to a mineral deficiency in your body or diet. In that case, however, it’s probably something to speak to your doctor about. They might also have a short-term effect in plumping up your remaining hair a bit.

Vin Diesel (left) and Dwayne Johnson (right) are rumoured to have had ATP.

ATP marking

Advanced Tricho Pigmentation (ATP) is a minimally invasive technique that essentially tattoos the appearance of closely shaved hair onto the scalp. The effect looks quite natural and actors Vin Diesel and Dwayne ‘The Rock’ Johnson are rumoured to have had ATP. It can be used for people who aren’t suitable for transplant, such as those who don’t have enough healthy follicles left to transplant effectively. It can also be used for eyebrows. The ATP ink usually lasts about six years and the procedure costs £1,000 to £3,000.

Prince William Credit:
Reuters

Growing bald gracefully

History is littered with sexy bald men: Sean Connery, Seal, Andre Agassi; and Prince William recently shaved down what locks he has left. Accepting - even embracing - hair loss is certainly less hassle than either chemical or surgical attempts to reverse it. What you definitely don’t want to do is make a poor attempt to disguise a burgeoning bald patch with a combover. That just looks ludicrous.

My hair transplant: before and after

Brian Beacom, 62, a journalist, had an FUT transplant ten years ago. "I was about to be bald and I reckoned that being bald would signal the end of my life. I spoke to trichologists and a hairdresser. I knew that when you become bald you look ten years older than you actually are.

"It can cause big self-esteem issues and had I been single it would have made a big difference. You don't get many leading men in films who are bald, and in my own life I wanted to be the romantic lead. If you're 5'8'' thin Scottish bald guy you look like a convicted felon."

He spent years researching the topic and eventually picked the Farjo Hair Institute. "I'd looked at Argentina and Turkey and then one day I was watching television and Duncan Bannatyne was on and he was talking about having a hair transplant and it looked good. So I researched Farjo and what I liked about them was they didn't try to sell me anything.

"The procedure was long - about 12 hours and that took me by surprise. But it was fairly relaxed. I would rather have a hair transplant than go to the dentist. You're drugged, of course, and you watch videos, you're fed and watered while people do things to your head that you're almost entirely aware of. But I had a constant excitement in my head that I had something to look forward to."

So how did it all turn out? "Great. Fantastic. Before, I wouldn't have gone to events and parties and got my picture taken. I was starting to shrink in public. But now the feeling's great. I wake up in the morning and reach for the hairdryer and blow it whatever way I want it to go.

"It's great - your hair can get untidy, it can get messed up. You can cut it short you can have it a bit longer. I'm delighted with it."